Delta Ⅲ prosthesis for acute fractures in elderly population with a 1-to 14-year follow-up

doi:10.3321/j.issn:1673-8225.2008.52.001

Abstract：The Delta Ⅲ semi-constrained reverse-ball-and-socket prosthesis works only with an intact deltoid muscle.In this study,we aimed to evaluate its effects on a consecutive series of acute complex fractures of the proximal humerus in elderly patients.From 1993 to 2007,forty-one Delta Ⅲreverse shoulder prostheses were implanted through an anterolateral approach for thirty-one three-part and four-part (Neer) fractures and ten fracture-dislocations.There were 3 men and 38 women with a mean age of 75 years.The Constant score and anterioposterior and lateral view X-rays were used for clinical and radiologic analyses,respectively.Nine patients died and two were navailable for follow-up,and 30 cases were enrolled for final analysis.At a mean follow-up of 6.5 years,the Constant scores were 59 points for the prosthesis side versus 80 for the contra-lateral side.The results were good in respect to pain (14.2),activity (14.4),strength (14.2),anterior elevation (7.5),abduction (6.5),but very poor for external (1) and internal (2.2) rotations.Radiographic results showed one case of aseptic glenoid loosening (at 12-year follow-up),seventeen cases of inferior scapular notching,fourteen of inferior spurs,four of medial and two of lateral proximal humeral bone losses,two of medial humeral lucent lines and one of septic humeral loosening.For complex acute fractures of the proximal humerus in the elderly,the Delta Ⅲ prosthesis is a possible alternative with reliable functional outcomes in cases in which traditional fixation methods may fail.Clinically,rotation remains low; radiographically,scapular notching and proximal humeral lysis are evident.